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Gestational diabetes - paradigm lost?

Gestational diabetes - paradigm lost?
Gestational diabetes - paradigm lost?
Despite a prodigious number of publications on the subject of gestational diabetes, great uncertainty persists about its significance and how it should be diagnosed. We suggest that the problem lies with concepts introduced over thirty years ago: first that gestational diabetes is a distinct disease requiring ‘diagnosis’ and second that this entity should include all degrees of glucose intolerance in pregnancy, with the presumption of equal risk across the range. We argue that fetal risks clearly differ according to the degree of maternal glycaemia, being greatest for those with previously undiagnosed diabetes and lowest for those with minimally raised blood glucose. In the latter, ‘gestational diabetes’ is primarily a risk factor for macrosomia and hypertension in pregnancy, but probably not the most important: maternal obesity and excessive gestational weight gain are of greater significance. From this perspective, gestational diabetes is a risk factor rather than a disease, and while there are good reasons to reduce the incidence of large babies and hypertension, it is more logical to look at all risk factors involved. The excessive ‘glucocentric’ focus and the quixotic pursuit of perfect diagnostic criteria in much recent research are hindering rather than helping our understanding
0742-3071
Cundy, T.
2d3cb0de-74da-4cb7-8884-207c37c0e0ca
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
Cundy, T.
2d3cb0de-74da-4cb7-8884-207c37c0e0ca
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393

Cundy, T. and Holt, Richard (2016) Gestational diabetes - paradigm lost? Diabetic Medicine. (In Press)

Record type: Article

Abstract

Despite a prodigious number of publications on the subject of gestational diabetes, great uncertainty persists about its significance and how it should be diagnosed. We suggest that the problem lies with concepts introduced over thirty years ago: first that gestational diabetes is a distinct disease requiring ‘diagnosis’ and second that this entity should include all degrees of glucose intolerance in pregnancy, with the presumption of equal risk across the range. We argue that fetal risks clearly differ according to the degree of maternal glycaemia, being greatest for those with previously undiagnosed diabetes and lowest for those with minimally raised blood glucose. In the latter, ‘gestational diabetes’ is primarily a risk factor for macrosomia and hypertension in pregnancy, but probably not the most important: maternal obesity and excessive gestational weight gain are of greater significance. From this perspective, gestational diabetes is a risk factor rather than a disease, and while there are good reasons to reduce the incidence of large babies and hypertension, it is more logical to look at all risk factors involved. The excessive ‘glucocentric’ focus and the quixotic pursuit of perfect diagnostic criteria in much recent research are hindering rather than helping our understanding

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Revised submission GDM commentary.pdf - Accepted Manuscript
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Accepted/In Press date: 29 June 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 397646
URI: http://eprints.soton.ac.uk/id/eprint/397646
ISSN: 0742-3071
PURE UUID: 53919360-548d-4f91-826c-c983119d8491
ORCID for Richard Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 01 Jul 2016 11:25
Last modified: 18 Feb 2021 16:56

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Contributors

Author: T. Cundy
Author: Richard Holt ORCID iD

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